Provider Demographics
NPI:1083394662
Name:BE BROOKSIDE
Entity Type:Organization
Organization Name:BE BROOKSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC
Authorized Official - Phone:816-287-0252
Mailing Address - Street 1:616 E 63RD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3370
Mailing Address - Country:US
Mailing Address - Phone:816-287-0252
Mailing Address - Fax:
Practice Address - Street 1:616 E 63RD ST STE 104
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3370
Practice Address - Country:US
Practice Address - Phone:816-287-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty